A member of the NICE guideline development group highlights the important issues from the latest evidence-based guideline for readers of Nursing Times
Public health guidance published in March (NICE, 2009) provides much-needed evidence-based care pathways for people with long-term sickness and incapacity. Most importantly, the guidance stresses the need for clinicians to consider the effects of their patients’ health on their ability to work and support themselves and their families. In the current economic climate, it is timely to suggest ways for health professionals to take a holistic view of managing their patients’ long-term conditions and preserving their work capacity whenever possible.
A multidisciplinary approach
The guidance recommends a multidisciplinary approach, and underlines the importance of communication between health professionals and employers, employment specialists and Jobcentre Plus. The first three recommendations cover activities which relate to employees who experience long-term sickness or recurring long or short-term sickness absence. These aim to encourage a well-managed return to work which will be of mutual benefit to both the employee and their employer. Recommendation 4 relates to activities for those who are unemployed and in receipt of incapacity benefits such as Employment and Support Allowance (ESA).
The guidance emphasises the importance of recording the occupation and main duties of all patients of working age who have long-term conditions, to facilitate appropriate assessment of their fitness to work, and advise on the need for workplace support or sickness absence. This is particularly important for primary care nurses, as recording occupational data during routine assessment and monitoring of patients with long-term conditions and at new patient medicals would make decision-making on work-related issues including sicknotes far easier.
The guidance on sickness absence suggests initial enquiries after employees have been off work for two to six weeks to determine the reason for the sickness, the prognosis, any barriers to returning to work, either actual or perceived, and what help may be needed. Occupational health nurses are ideally placed to carry out these actions, and to undertake further assessment of the patient and negotiate a return to work plan with their line manager.
Occupational health nurses offer a confidential service which should be trusted as impartial by employees, yet they are able to communicate directly with managers, visit the workplace if necessary, and obtain further health-related information from the patient’s GP and/or acute care. However, many smaller employers do not have access to occupational health services, and even among companies who do commission or provide occupational health for their employees, there has hitherto not been a consistent approach to sickness absence management. This guidance clarifies what should be provided at each stage of absence, which will help occupational health and primary care professionals manage patients more effectively, and facilitate appropriate commissioning of occupational health services.
The guidance outlines evidence-based interventions for long-term sickness absence; these distinguish between people needing advice and support, and those who will need more intensive intervention. Recommended interventions for different types of conditions include cognitive behavioural therapy, graded activity, physiotherapy, progressive goal attainment programmes and workplace modifications. It stresses the importance of assessment and case coordination, which can be provided by suitably trained and skilled nurses. This is important because, without adequate and timely assessment, some interventions have been shown to increase the time taken to return to work either by being provided too late, or by taking longer than necessary for the severity of the person’s condition.
In her review of the health of Britain’s working-age population, Working for a Healthier Tomorrow, Dame Carol Black recommends a Fit for Work service, which will shortly be piloted in different areas of the country. This new service will employ case workers as recommended by NICE, in a variety of different locally determined models. This could include opportunities for nurses who are interested in this emerging field. Condition management programmes for claimants of incapacity benefits and ESA also continue to provide opportunities for nurses to work in assessment and holistic management of long-term sickness and incapacity.
NICE guidance on long-term sickness and incapacity therefore provides clearly evidenced care pathways to help people with long-term conditions remain economically active and independent, and the nursing profession is at the heart of many of the proposed developments, particularly in primary care and workplace health.
AUTHOR Fiona Ford, MBE, MRCGP, is an academic GP, East Lancashire and a member of the NICE guideline development group.
NICE (2009) Management of Long-term Sickness and Incapacity for Work. London: NICE.